Implementing a Band 4 Urethral Catheterisation Pathway within an Urgent Community Response and Virtual Frailty Ward Service

Introduction
Urgent Community Response (UCR) and Virtual Frailty Ward (VFW) services provide acute care at home for older adults living with frailty. Increasing referrals for urgent catheter care, including blocked catheters and urinary retention, placed pressure on clinical capacity and challenged delivery of the national two-hour response standard. To address this, Berkshire Healthcare NHS Foundation Trust UCR developed a governance-approved pathway enabling experienced Band 4 support workers to undertake uncomplicated urethral catheterisation under the Trust delegation policy, following approval from the Trust Safety, Experience, Clinical Effectiveness and Governance (SECEG) group.

Methods
A pilot was undertaken between November 2023 and October 2024. Band 4 support workers completed Trust urethral catheterisation training, supervised practice and competency assessment. A Standard Operating Procedure defined patient selection, delegation, documentation, risk assessment, escalation and clinical supervision. Senior clinical support was required for complex cases, difficult catheterisations, unexpected findings or reduced confidence. Clinical leads and shift coordinators provided ongoing governance and oversight.

Results
During the pilot, 494 urethral catheter referrals were received, with 91% accepted and managed within the two-hour response target, compared with 88% pre-pilot. Band 4 support workers completed 31.8% of urethral catheterisations during the pilot, increasing to 36.9% following implementation, and undertook 257 catheter changes. No catheter-related clinical incidents were reported. Two procedures required escalation to senior clinicians, demonstrating appropriate supervision and safe clinical decision-making. Staff reported increased confidence, competence and autonomy, while clinicians described improved service capacity and deployment of senior practitioners for more complex interventions.

Conclusions
A structured training, supervision and competency pathway enabled Band 4 support workers to safely undertake uncomplicated urethral catheterisation, increasing workforce flexibility, releasing senior clinical capacity and supporting timely frailty care at home. This workforce model improved service resilience and offers a transferable approach for community and frailty services managing increasing demand.